ATI LPN
Gastrointestinal System Nursing Exam Questions Questions
Question 1 of 5
A patient has a history of chronic iron deficiency anemia requiring a recent blood transfusion. She has undergone an extensive GI work-up including upper endoscopy, colonoscopy, capsule enteroscopy, and abdominal CT scan. Her only medications are ferrous sulfate, baby aspirin, COX II inhibitor, and HCTZ. Which statement is true?
Correct Answer: B
Rationale: Dedicated small bowel series is typically of low yield in the diagnostic evaluation of chronic iron deficiency anemia. Provocative arteriograms have been performed in patients with gastrointestinal hemorrhage of obscure origin, but only a small series of cases have been reported, and it remains to be determined if this therapy can truly be done safely with a significant diagnostic yield. Hormonal therapy has been given to patients with arteriovenous malformations, but a randomized controlled trial published in 2001 showed no benefit using ethinyl estradiol and norethisterone in reducing recurrent bleeding in patients with angiodysplasia. It is important to recognize that even a baby aspirin a day can decrease the benefit in mucosal protection gained from using a COX II selective inhibitor.
Question 2 of 5
A 62-year-old woman presents to the emergency room complaining of abdominal pain. The patient had a laparoscopic cholecystectomy for multiple small gallbladder stones eight months ago. She did not have any symptoms after the surgery until last week, when she suddenly developed pain in the right upper quadrant. The painful episode lasted 15 minutes. The next day, the pain returned and became constant. The intensity of pain gradually increased. Today she started to have nausea and vomiting, and her daughter brought her to the emergency room. The patient is febrile (her temperature is 38.6°C) and is jaundiced. Physical examination revealed localized tenderness in the right upper quadrant without a palpable mass. Her blood work showed white blood cell count 16.4/ L, total bilirubin 6.3 mg/dL, alkaline phosphatase 347 IU/L, amylase 53 U/L, and lipase 32 U/L. Which of the following would you order next for this patient?
Correct Answer: C
Rationale: The patient presents with obstructive jaundice and cholangitis. The most likely cause is a retained gallstone or a stricture that developed postcholecystectomy. An HIDA scan, viral hepatitis screening, and liver biopsy are not indicated in this patient with obvious bile duct obstruction. An ERCP may identify the cause of obstruction. Endoscopic sphincterotomy with removal of the stone, or dilatation and stenting of the biliary stricture, will restore patency of the biliary system to cure cholangitis and obstructive jaundice. If ERCP is not successful, the patient will need percutaneous transhepatic drainage of the biliary ducts or laparotomy with the common bile duct exploration.
Question 3 of 5
A 56-year-old man has had profuse watery diarrhea for three months. Measured stool electrolytes are as follows: Na 30 mmol/L, K+ 85 mmol/L, Cl- 15 mmol/L, and HCO3- 18 mmol/L. Which diagnosis is least likely?
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 4 of 5
A 24-year-old man presents with emotional lability and jaundice. Labs reveal a hemoglobin of $10 \mathrm{~g} / \mathrm{dL}$, total bilirubin of $8 \mathrm{mg} / \mathrm{dL}$ with direct fraction of 2.2, alkaline phosphatase of 89 U/L, AST and ALT in the 1500 U/L range, negative viral serologies, and negative toxicology screen. Which of the following is correct?
Correct Answer: D
Rationale: This is an acute presentation of Wilson's disease. The patient has neuropsychiatric symptoms, liver disease, and evidence of hemolytic anemia. Ceruloplasmin in this setting is not reliable because it is an acute phase reactant. The diagnosis is best made by quantifying copper in liver tissue, but a 24-hour urinary copper is also a very sensitive tool and will show greater than $100 \mathrm{~g}$ of copper.
Question 5 of 5
A 52-year-old man with a history of hypertension presents for a follow-up visit. He denies any complaints. His only medication is hydrochlorothiazide. He has some laboratory tests done that reveal mild elevations of his ALT and AST levels. His total bilirubin and alkaline phosphatase levels are normal. He is brought back to have his tests repeated and to have further testing. His AST and ALT are still elevated. His iron studies are normal. His hepatitis C antibody is negative. His hepatitis A IgM is negative. His hepatitis B surface antigen and antibody are negative. His IgM antibody to hepatitis B core antigen (IgM anti-HBc) is positive. Which of the following statements is correct?
Correct Answer: D
Rationale: The most specific marker for the diagnosis of acute hepatitis B is IgM antibody to hepatitis B core antigen (IgM anti-HBc). However, false positives can occur. Chronic carriers of hepatitis B will typically have a positive hepatitis B surface antigen (HbsAg) and a positive IgG antibody to hepatitis B core antigen (IgG anti-HBc). Patients may sometimes be low-level carriers with a negative HbsAg and only a positive IgG anti-HBc. Hepatitis D requires the presence of HbsAg to cause infection. It is associated with acute HBV infection (predominantly in intravenous drug users) but the overall incidence is low. When a patient presents with this pattern, repeating the tests in two to three months may assist in the diagnosis. If the IgM anti-HBc disappears and either a hepatitis B surface antibody or IgG anti-HBc appears, then it is likely that he had an acute infection.